Citation Nr: 0520087
Decision Date: 07/22/05 Archive Date: 08/03/05
DOCKET NO. 99-09 269 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Boston,
Massachusetts
THE ISSUE
Entitlement to service connection for a psychiatric disorder.
REPRESENTATION
Appellant represented by: Disabled American Veterans
ATTORNEY FOR THE BOARD
Joseph P. Gervasio, Counsel
INTRODUCTION
The veteran served on active duty from September 1956 to
September 1960.
This matter is before the Board of Veterans' Appeals (the
Board) on appeal from a rating decision dated in February
1999 of the Department of Veterans Affairs (VA) Regional
Office in Boston, Massachusetts, (the RO), which determined
that new and material evidence had not been submitted to
reopen the claim for service connection for a psychiatric
disorder. In an August 2000 decision, the Board determined
that new and material evidence had been submitted and the
Board reopened the claim for service connection for a
psychiatric disorder. The Board then remanded this matter to
the RO for additional development.
The Board then denied the appellant's claim for service
connection for a psychiatric disorder in an August 2002
decision. The appellant appealed the Board's denial to the
United States Court of Appeals for Veterans Claims (Court),
and the Board's decision was vacated pursuant to an April
2003 Order, following a Joint Motion for Remand and to Stay
Further Proceedings. The parties requested that the Court
vacate the Board's August 2002 decision regarding the denial
of service connection for a psychiatric disorder and remand
the matter so that the Board could satisfy the duty to notify
under the Veterans Claims Assistance Act of 2000 (VCAA). The
Court granted the joint motion and remanded the case to the
Board.
The Board, in December 2003, remanded the case to the Appeals
Management Center (AMC) for further development and
consideration. The AMC complied with the provisions of the
Board's remand and the claim has been returned to the Board
for further adjudication.
FINDING OF FACT
A psychiatric disorder is not shown during service or until
many years thereafter and is not shown to have been caused by
any in-service event.
CONCLUSION OF LAW
A psychiatric disorder was neither incurred in nor aggravated
by service nor may it be presumed to have been incurred
therein. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137
(West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2004).
REASONS AND BASES FOR FINDING AND CONCLUSION
The Veterans Claims Assistance Act of 2000 (VCAA) eliminates
the concept of a well-grounded claim, and redefines the
obligations of VA with respect to the duty to assist. See,
38 U.S.C.A. §§ 5102, 5103, 5103, 5107 (West 2002). The law
includes an enhanced duty to notify a claimant as to the
information and evidence necessary to substantiate a claim
for VA benefits. The final rule implementing the VCAA, which
was published on August 29, 2001 has been codified at 38
C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a).
The United States Court of Appeals for Veteran Claims'
(Court's) decision in Pelegrini v. Principi, 18 Vet. App. 112
(2004), held, in part, that a VCAA notice, as required by
38 U.S.C. § 5103(a), must be provided to a claimant before
the unfavorable agency of original jurisdiction (AOJ)
decision on a claim for VA benefits. The notification must:
(1) inform the claimant about the information and evidence
not of record that is necessary to substantiate the claim;
(2) inform the claimant about the information and evidence
that VA will seek to provide; (3) inform the claimant about
the information and evidence the claimant is expected to
provide; and (4) request or tell the claimant to provide any
evidence in the claimant's possession that pertains to the
claim, or something to the effect that the claimant should
"give us everything you've got pertaining to your
claim(s)." This new "fourth element" of the notice
requirement comes from the language of 38 C.F.R.
§ 3.159(b)(1).
The Board finds that the RO has provided the veteran with the
appropriate notice for compliance with the VCAA. In this
regard the RO notified the appellant of the requirements
necessary to establish his claim in the statement of the case
and supplemental statements of the case. In addition, the
veteran was furnished a letter in February 2004 that provided
notification of the information and medical evidence
necessary to substantiate this claim, the information and
evidence that VA would seek to provide, and the information
and evidence the appellant was expected to provide. In
addition, the RO asked the appellant to submit information
regarding any evidence that is believed to pertain to the
claim. See 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R.
3.159(b) (2003); Quartuccio v. Principi 16 Vet. App. 183
(2002).
The Board finds that any defect with respect to the timing of
the VCAA notice requirement was harmless error. See
Mayfield v. Nicholson, 19 Vet. App. 103 (2005). Although the
notice provided to the veteran in 2004 was not given prior to
the first adjudication of the claim, the content of the
notice fully complied with the requirements of 38 U.S.C. §
5103(a) and 38 C.F.R. § 3.159(b), and, after the notice was
provided, the case was readjudicated and an additional SSOC
was provided to the veteran in February 2005.
The RO has also made reasonable efforts to obtain relevant
records adequately identified by the veteran. The veteran
has been afforded a VA examination during the course of this
claim and had the opportunity for a hearing on appeal. Thus,
under the circumstances in this case, VA has satisfied its
duties to notify and assist the veteran, and adjudication of
this appeal poses no risk of prejudice to the veteran. See,
e.g., Bernard v. Brown, 4 Vet. App. 384, 394 (1993).
Service medical records are unavailable and been certified by
the National Personnel Records Center as being presumably
destroyed by fire. The veteran first claimed service
connection for a psychiatric disorder in 1995.
A neuropsychological consultation report, dated in July 1983,
indicates that the veteran was being evaluated at a private
hospital after being found in the basement of his burnt home
by his family. It was reported that the veteran had fired
guns in the home and had told police that he attempted
suicide although he later denied this. The veteran's family
reported that he had been acting strangely for over six
months and his behavior included severely beating his 18 year
old daughter. The consultation report indicates that the
veteran's past medical history was unremarkable. A
consulting neurologist stated that the impression was that
the veteran most likely had a psychotic depression and this
was possibly a manifestation of a bipolar illness with a
report of excessive working being a sign of hypomanic
activity. The neurologist stated that the veteran did have
neurological soft signs in the right nasolabial fold
flattening and the reflex asymmetries as well as the six
month behavioral change. Additional tests were ordered.
A July 28, 1983 competency evaluation report reveals that the
veteran was admitted to the Hospital by order of the District
Court for an opinion as to the veteran's competence and his
criminal responsibility. The veteran reported that he spent
four years on active duty and two years on Reserves. It was
noted that the veteran apparently had no history of serious
physical problems. The evaluation report notes that six
months prior, the veteran had assaulted his daughter. The
probation officer indicated that it was a serious assault.
It was noted that the veteran's use of alcohol was
questionable. The evaluator conferred with the veteran's
former private therapist who saw him approximately eight
times two or three years earlier. The former therapist
indicated that he thought the veteran was a manic-depressive
for whom medication would have been useful but the veteran
did not follow through with those recommendations. The
former therapist questioned whether the veteran also had a
drinking problem. It was the evaluator's opinion that the
veteran had a bipolar illness with several periods of time
throughout the year in which his mood was predominantly
elevated, expansive and irritable. The evaluator stated that
the veteran had had this disorder for two or three years and
perhaps longer but that he did not come to the attention of
the mental health community until he had the incident in his
basement.
The veteran was again hospitalized at a private facility in
September 1992. A Magnetic Resonance Imaging (MRI) scan of
the veteran's brain revealed findings consistent with an old
left frontal pole extracerebral hematoma of indeterminate
age. The veteran underwent neurological examination. At
that time, he reported being knocked out by a blow to the
head by a fist when he was in his 20's. The veteran reported
that he was unconscious for only a few minutes, and that he
did not go to a hospital and did not have headaches
afterward. Upon examination, the veteran's mental status was
unremarkable. The examiner's impression was that a subdural
hematoma could occur with a trivial head injury, and that it
could resolve to thick organized fibrous tissue. The
examiner noted that the subdural hematoma may relate to
slight sidedness in motor examination, but that it did not
contribute to the veteran's present psychiatric state.
A September 1992 neuropsychological consultation report
indicates that the neuropsychologist indicated that the
veteran may have sustained a closed head injury at some
earlier time that went untreated and that the veteran
described such an injury with loss of consciousness occurring
several years earlier. The neuropsychologist noted that
although the veteran's psychiatric disorder probably
contributed to the neuropsychological picture, the pattern
and extent of cognitive deficits particularly his verbal
memory problems suggested cortical deficits above and beyond
those typically seen in psychiatric patients. The
neuropsychologist noted that the MRI results supported this
conclusion. The neuropsychologist stated that the veteran's
disinhibited and impulsive behavior, verbal memory deficit,
disorganized and confabulatory responses, contextual
blurring, impaired word list generation, impaired self-
control motor functions, and motor perseveration were all
consistent with the neuropsychological profile of a head-
injured patient. The neuropsychologist stated that an
exacerbation of the veteran's psychiatric symptoms
superimposed on a head injury may account for his current
neuropsychological profile. The neuropsychologist also
stated that an alternative explanation for his cognitive
deficits was early stage Alzheimer's disease, though this
possibility was less likely given his preserved confrontation
naming and visual memory abilities. The neuropsychologist
also noted that the veteran's conflation and confabulatory
tendencies were consistent with chronic alcohol abuse
however, the veteran denied a history of heavy drinking.
An October 1993 Social Security Administration (SSA) decision
indicates that the veteran was disabled due to various
disorders including severe bipolar disorder, manic, with
psychotic features and a chronic subdural hematoma. The SSA
decision indicates that the record reveals that the veteran
had a lengthy history of severe mood swings, impulsivity, and
"severe out of control behavior." It was reported that the
loss of his home to a fire in 1983 had led to a suicide
attempt and a three month hospitalization at a state hospital
where bipolar disorder, manic was diagnosed and treatment
with lithium citrate was instituted. The SSA records note
that another maniac episode and associated charges of assault
to commit rape resulted in another stay in the state hospital
from November 1984 to January 1985. The report indicates
that since the veteran's first hospitalization, he remained
in outpatient psychiatric treatment. It was indicated that
during July 1992, the veteran had become increasingly
agitated, irritable, angry, and impulsive and he had
increased energy, insomnia, and diminished appetite with
weight loss. The veteran had auditory hallucinations,
delusional thinking, extreme hostility, bizarre behavior, and
homicidal and suicidal ideation. He was hospitalized at that
time for psychiatric care. During the four week stay, the
veteran's medication were adjusted. Evaluations during the
hospital stay produced evidence of a chronic subdural
hematoma which appeared to affect his motor functioning, but
not his psychiatric state.
The veteran underwent a VA examination in October 1995. The
examiner noted that the entire history was provided by the
veteran and his spouse and a claims file was not available.
Regarding service, the veteran stated that he may have had
psychiatric problems in service. He reported that when he
went out with friends in Germany, after a few drinks, he
would end up in fights. He reported that he was an
organizational supply specialist. Upon examination, the
veteran spoke in a disjointed fashion, repeating himself
quite often. His answers were not always coherent and
relevant. The examiner questioned whether the veteran was
already hypomanic while in service. It was noted that the
veteran was in need of long-term psychiatric follow-up care.
The diagnosis was bipolar disorder, chronic, severe, mixed.
In September 1998, an undated case report was received. The
report indicated that the veteran's boxing years could have
caused irreversible brain damage, contributing to his
psychosis, and that the chronic subdural hematoma could have
been sustained during his boxing years.
In a September 1998 medical statement, the veteran's private
psychiatrist stated that the veteran had had a bipolar
affective disorder for many years. It was indicated that,
while the veteran's formal psychiatric history dated back to
the 1980's, his history included previous head trauma and
radiographic evidence of a subdural hematoma. It was this
physician's opinion that it was certainly conceivable that
this trauma to the veteran's head had contributed adversely
to the veteran's overall neuropsychiatric condition.
In a July 1999 statement, the veteran reported that he had
enlisted in the Air Force in 1956 and he had no physical or
psychological problems. He stated that he was on a boxing
team in Europe during 1958 and 1959 where he participated in
the Armed Forces Intramural Boxing Teams. He stated that he
was involved in numerous matches and boxing events and stated
that during one of the matches, he was knocked down and he
hit the back of his head and he was knocked unconscious. As
the years went by, he said that he had developed a subdural
hematoma which developed into his present psychiatric
disorder and neuropsychological problems. The veteran
asserted that he was treated at a private hospital where the
treating physicians and psychologists have given the veteran
medical opinions that his current condition was related to
the blow to the head that he received in service.
The veteran underwent a VA neurological examination in August
1999. He reported that he was in a boxing match in service
in 1958, that he was hit in the face and knocked backwards,
that he hit the back of his head, and he was rendered
unconscious for several minutes. He noted that he had been
able to get up and return to his barracks, retiring to full
active duty. The examiner noted that the veteran, himself,
was unable to give much of a coherent history, and that he
was dependent in activities of daily living.
The neurologic diagnosis was contusion, left frontal subdural
hematoma. The examiner noted that the veteran had a brief
loss of consciousness in a boxing fight in 1958, and had had
a long course of severe and debilitating psychiatric
difficulties that may or may not predate that injury. The
examiner stated that there was evidence of a left frontal
pole subdural hematoma. The examiner was asked for an
opinion as to the relationship, if any, between the veteran's
head trauma and his current neuropsychiatric condition. The
examiner opined that the nature of the veteran's head injury
with brief loss of consciousness and left frontal pole
subdural hematoma would not contribute significantly to the
veteran's current neuropsychiatric dysfunction. The examiner
did not think that the veteran's current level of functioning
was a direct result of his head injury.
The veteran underwent a VA mental disorders examination in
August 1999. The examiner noted that the veteran was not a
good historian and that his wife assisted him. Upon
examination, the veteran's memory was patchy at best. The
diagnosis was bipolar disorder, II. Records show that the
examiner was asked for an opinion as to the relationship, if
any, between a boxing injury in 1958 and his current
psychiatric condition. The examiner opined that it was not
possible to make a direct connection between the two. It was
noted that from talking to the veteran's spouse and reviewing
hospital reports and the letter from the veteran's
psychiatrist, it would seem that a head trauma experienced in
service and the subsequent problems the veteran had had would
contribute to any psychiatric illness subsequent to the
injury.
In a March 2002 statement a private neurologist, stated that
the veteran was being followed for frontal lobe syndrome of a
complex nature. It was noted that while the veteran was in
service, he had reportedly sustained a head injury while
boxing. In 1992 it was discovered that the veteran had a
calcified left frontal subdural hematoma. The physician
stated that a diagnosis of bipolar illness was made but also
the presence of organic brain dysfunction consistent with
trauma was clearly established. He stated that the veteran
underwent treatment for anterior cerebral artery aneurysm,
which was uneventful. It was noted that the veteran
exhibited some symptoms consistent with tardive dyskinesia
reflecting antipsychotic drugs, and most recently, he has
improved with alteration of his medications. It was this
physician's opinion that the head injury resulted in the
subdural hematoma, which by 1992 was calcified and quite
small. It was stated that it was more likely than not that
this head injury was significant and played a role in the
induction of the neurologic syndrome currently evident with
many influencing factors as described above.
In a March 2002 statement, a behavioral neurologist stated
that the veteran was referred for a second opinion. It was
noted that the veteran reported having at least one head
injury during his second decade. The veteran reported that
he was pushed backwards and hit his head on cement. The
veteran noted that he was in the Air Force and he
participated in the Olympic Boxing Team of the Armed Forces.
The veteran's medical records and medical history were
reviewed. It was stated that the veteran had evidence of
frontotemporal dementia superimposed on a longstanding
frontal encephalopathy with an organic brain disorder. In
the physicians professional opinion, after review of the
veteran's history, as documented above and available in his
records, it was more likely than not that the current
psychiatric condition was directly due to his suffering a
head injury while on active duty in the Air Force. The
veteran's prognosis was poor and he would never return to
full intellectual capacity and he was likely to get worse as
he aged.
VA outpatient treatment records, dated through February 2005,
have been received. These primarily show treatment for
disabilities unrelated to this appeal, including the
veteran's dementia, and do not contain medical opinions
regarding the etiology of the veteran's psychiatric disorder.
In order to establish service connection for a claimed
disability, the facts, as shown by the evidence, must
demonstrate that a particular disease or injury resulting in
current disability was incurred during active service or, if
preexisting active service, was aggravated therein.
38 U.S.C.A. §§ 1110, 1131. In addition, certain chronic
diseases, including a psychosis, may be presumed to have been
incurred during service if they first become manifest to a
compensable degree within one year of separation from active
duty. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R.
§§ 3.307, 3.309. If a condition noted during service is not
shown to be chronic, then generally a showing of continuity of
symptoms after service is required for service connection. 38
C.F.R. § 3.303(b).
The veteran asserts that he is entitled to service connection
for a psychiatric disorder, contending that he was on an
Armed Forces Boxing team and he incurred a head injury when,
while boxing, he was knocked down and he hit the back of his
head on cement. He stated that he was knocked unconscious.
The veteran asserts that this led to the development of a
subdural hematoma which developed into his current
psychiatric disorder and neuropsychological problems.
As discussed above, the veteran's service medical records are
unavailable and have been destroyed. The Court of Appeals
for Veterans' Claims (Court) has held that in cases where
records once in the hands of the government are lost, the
Board has a heightened obligation to explain its findings and
conclusions and to consider carefully the benefit-of-the-
doubt rule. O'Hare v. Derwinski, 1 Vet. App. 365, 367
(1991). The Board's analysis has been undertaken with this
heightened duty in mind. The case law does not, however,
lower the legal standard for proving a claim for service
connection but rather increases the Board's obligation to
evaluate and discuss in its decision all of the evidence that
may be favorable to the appellant. Russo v. Brown, 9 Vet.
App. 46 (1996).
There is medical evidence which establishes that the veteran
currently has a psychiatric disorder. The medical evidence
of record reflects a diagnosis of bipolar disorder. The
medical evidence dated in 2002 also reflect diagnoses of
organic brain dysfunction and frontotemporal dementia
superimposed on a longstanding frontal encephalopathy with an
organic brain disorder.
The veteran's service medical records have not been located
and are presumed to be destroyed. The veteran has not
submitted any medical evidence showing treatment of a bipolar
disorder in service or soon after service separation. There
is no competent evidence of manifestation of bipolar disorder
to a compensable degree within one year from service
separation in September 1960. Thus, service connection for
bipolar disorder on a presumptive basis is not warranted.
See 38 C.F.R. § 3.307, 3.309.
The Board finds that the evidence of record shows that the
veteran's psychiatric disorder, bipolar disorder, was first
manifested more than 20 years after service separation. The
medical evidence of record shows that the veteran's
psychiatric disorder first manifested in the early 1980's.
Hospital records dated in July 1983 indicate that the
veteran's former therapist, who had treated the veteran in
the early 1980's, stated that the veteran had manic-
depression and a possible drinking problem. Bipolar disorder
was detected in July 1983 when the veteran was hospitalized
after a suicide attempt. The 1983 hospital records indicate
that the veteran most likely had a psychotic depression which
was possibly a manifestation of bipolar illness. According
to the veteran's family, his violent and strange behavior had
started six months earlier.
The veteran and his representative assert that the veteran
developed a bipolar disorder due to a subdural hematoma that
was incurred in service while the veteran was a boxer. The
Board finds that the evidence of record does not support this
contention.
There is medical evidence that the veteran has a subdural
hematoma. September 1992 hospital records indicate that an
MRI scan of the veteran's brain revealed findings consistent
with an old left frontal pole extracerebral hematoma. The
age of the hematoma was indeterminate.
There is no medical evidence that the subdural hematoma was
incurred in service. The only evidence of service incurrence
of the subdural hematoma is the veteran's own statements.
The veteran's own implied assertions that he incurred a
hematoma due to the alleged head injury in service are
afforded no probative weight in the absence of evidence that
the veteran has the expertise to render opinions about
medical matters. Although a layperson, such as the veteran,
is competent to testify as to his symptoms, where the
determinative issue involves a question of medical diagnosis
or causation, only individuals possessing specialized medical
training and knowledge are competent to render such an
opinion. See Espiritu v. Derwinski, 2 Vet. App. 492, 494-5
(1992).
The Board also finds that the veteran's statements regarding
the alleged head injury in service to have no credibility.
The Board points out that the veteran did not allege that he
incurred a head injury in service due to a boxing injury
until he filed the application to reopen the claim for
service connection for a psychiatric disorder in 1998. When
the veteran initially filed the claim for service connection
for a psychiatric disorder in 1995, he made no mention of a
head injury in service. He did not report incurring a boxing
injury. The veteran did not report incurring a head injury
in service at the October 1995 VA examination. He did report
that he would have a few drinks in service and then would end
up fighting. The veteran reported that he was an
organizational supply specialist. He did not mention that he
was on the Armed Forces Boxing team. The Board also points
out that the hospital records dated in 1983 and 1992 make no
mention of an in-service head injury due to boxing. The 1983
hospital records indicate that the veteran's past medical
history was unremarkable. The hospital records note the
veteran's violent behavior, but there is no indication that
the veteran incurred a head injury in service. The September
1992 hospital records indicate that the veteran did report
being knocked out in his twenties by a blow from a fist, but
the veteran did not indicate that this occurred during
service or when he was a boxer in service. He also was
described as tending to confabulate and conflate. This is a
medical observation that diminishes the credibility of any
historical information he gives.
The Board also points out that the medical evidence of record
shows that the veteran was incompetent and incoherent at the
time the veteran made the statements regarding the alleged
inservice head injury. The Board notes that the veteran
submitted a statement in July 1999 in which he described in
detail the head injury in service. However, the medical
evidence of record shows that upon examination in October
1995, the veteran spoke in a disjointed fashion and his
answers were not always coherent and relevant. Upon
examination in August 1999, the VA examiners indicated that
the veteran himself was unable to give much of a coherent
history and the spouse assisted the veteran with the report
of history. The VA examiner who performed the VA psychiatric
examination stated that the veteran was not competent. Thus,
the Board finds that it is highly unlikely that the veteran
himself drafted the July 1999 statement detailing the claimed
in-service head injury.
Although the Board must take into consideration the veteran's
statements, it may consider whether self-interest may be a
factor in making such statements. See Cartright v.
Derwinski, 2 Vet. App. 24, 25 (1991); Pond v. West, 12 Vet.
App. 341, 345 (1999). In this case, the Board finds that the
veteran's statements that he incurred a head injury in
service are self-serving and not credible because such
statements are inconsistent with previous statements made.
Furthermore, the most detailed statements appear to be made
by a person other than the veteran.
The veteran has provided statements by various health care
providers that indicate that the head trauma in service
caused the subdural hematoma and led to the development of
the veteran's bipolar disorder and the neuropsychiatric
disorders. The Board notes that in the September 1998
medical statement, the veteran's psychiatrist opined that it
was certainly conceivable that the trauma to the veteran's
head had contributed adversely to the veteran's overall
neuropsychiatric condition. In a March 2002 statement, a
neurologist, stated that it was her opinion that the head
injury resulted in the subdural hematoma which by 1992 was
calcified and quite small. In a March 2002 statement, the
behavioral neurologist, stated that based upon review of the
veteran's history and records, it was more likely than not
that the veteran's current psychiatric condition was directly
due to the head injury in service while on active duty in the
Air Force. Also, the VA psychiatrist who performed the
August 1999 VA psychiatric examination stated that from
talking to the veteran's spouse and reviewing hospital
reports and the letter from the veteran's psychiatrist, it
would seem that the head trauma experienced in service and
the subsequent problems the veteran has had would contribute
to any psychiatric illness subsequent to the injury.
The Board is charged with the duty to assess the credibility
and weight to be given to the evidence. Klekar v. West, 12
Vet. App. 503, 507 (1999); Wood v. Derwinski, 1 Vet. App.
190, 193 (1991). Indeed, the Court has declared that in
adjudicating a claim, the Board has the responsibility to do
so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson
v. Derwinski, 2 Vet. App. 614, 618 (1992). In doing so, the
Board is free to favor one medical opinion over another,
provided it offers an adequate basis for doing so. Evans v.
West, 12 Vet. App. 22, 30 (1998); Owens v. Brown, 7 Vet. App.
429, 433 (1995).
The Board finds that these medical statements are speculative
and have limited probative value. In Black v. Brown, 5 Vet.
App. 177, 180 (1993), the Court stated that the Board may
discount medical opinions that amount to general conclusions
based on history furnished by the claimant and that are
unsupported by the clinical evidence. It is clear that the
psychiatrists, neurologist and the behavioral neurologist
were basing their conclusions upon the veteran's and the
veteran's spouse's statements, since there is no independent
evidence that the veteran sustained a head injury in service
or that he incurred a hematoma in service. The veteran
himself stated that he did not obtain medical treatment for
the alleged head injury. The psychiatrists, neurologist and
the behavioral neurologist do not cite to the medical
evidence which supports their medical conclusions.
Furthermore, the Board points out that there are two medical
statements by neurologists that indicate that the hematoma
did not contribute to the veteran's present psychiatric
state. In the September 1992 medical statement, the
neurologist reviewed the veteran's MRI findings that detected
the subdural hematoma. The neurologist stated that the
hematoma may relate to the veteran's slight sidedness in
motor examination, but that it did not contribute to the
veteran's present psychiatric state. The VA neurologist who
performed the August 1999 VA neurological examination stated
that the left frontal pole subdural hematoma would not
contribute significantly to the veteran's current
neuropsychiatric dysfunction. The Board finds these medical
opinions to be highly probative. In evaluating the probative
value of medical statements, the Board looks at factors such
as the health care provider's knowledge and skill in
analyzing the medical data. See Guerrieri v. Brown, 4 Vet.
App. 467, 470-71 (1993); see also Black v. Brown, 10 Vet.
App. 279, 284 (1997). The Board finds that the neurologists
are specialists in the diseases of the brain and they have
the medical competence to render a medical opinion as to
whether a hematoma could cause a psychiatric disorder.
In Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000), the
Federal Circuit indicated that a veteran seeking disability
benefits must establish the existence of a disability and a
connection between the veteran's service and the disability.
In the present case, the veteran has not submitted competent
evidence of a connection between the veteran's service and
his psychiatric disorder. The medical evidence shows that
the bipolar disorder first manifested approximately 20 years
after service. The medical evidence shows that the veteran
has a subdural hematoma, but there is no credible evidence
that the subdural hematoma was incurred in service. The
medical evidence of record shows that the age of the hematoma
was indeterminate. Thus, the Board finds that service
connection for a psychiatric disorder is not warranted, since
the preponderance of the evidence shows that the psychiatric
disorder was not incurred in service and there is no evidence
of a relationship between the current psychiatric disorder
and disease or injury during service. All of the favorable
medical opinions rest on the veteran's reported history of a
head injury in service. Without that history there is no
connection to service. The Board rejects that history as not
credible. The Board concludes that the preponderance of the
evidence of record is against the veteran's claim, and the
claim is therefore denied.
The preponderance of the evidence is against the claim, and
therefore the benefit of the doubt doctrine is inapplicable.
38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49
(1990).
ORDER
Service connection for a psychiatric disorder is denied.
____________________________________________
J. E. DAY
Veterans Law Judge, Board of Veterans' Appeals
Department of Veterans Affairs